Abstract
Skin-picking disorder (SPD) is a common mental disorder characterized by recurrent and excessive picking of dermatological irregularities. Different disorder models have been developed to explain this behavior, but empirical evidence is still scarce. One model (the disgust-related disease avoidance model) suggests that SPD might be understood as pathological grooming elicited by skin imperfections that singal possible infection. Twenty-five women with SPD and 19 matched controls viewed and rated images depicting skin irregularities and smooth skin during functional magnetic resonance imaging. The participants did not engage in picking behavior. Relative to controls, SPD patients reported more disgust and urge to pick when looking at skin irregularities. This was accompanied by greater activation in the insula and amygdala, and stronger insula-putamen coupling. Disgust feelings elicited by viewing skin irregularities were positively correlated with activation of the insula and the putamen, in the clinical group. On personality questionnaires, the SPD patients reported elevated self-loathing and problems in regulating their disgust feelings. The current study provides first evidence for altered disgust processing in SPD patients.
Highlights
Several mental disorders are associated with nonsuicidal self-injury, defined as the deliberate, self-inflicted destruction of body tissue
In the DSM-5 (American Psychiatric Association 2013), skin-picking disorder (SPD) is listed in the section of obsessive–compulsive and related disorders (OCD)
SPD patients reported elevated feelings of disgust when confronted with visual cues of dermatological problems, and showed increased activation of the left insula and left amygdala relative to controls
Summary
Several mental disorders (e.g., borderline personality disorder, eating disorders) are associated with nonsuicidal self-injury, defined as the deliberate, self-inflicted destruction of body tissue (e.g., scratching, biting or cutting skin). Another often undiagnosed serious condition, skin-picking disorder (SPD), is characterized by recurrent and excessive picking of dermatological irregularities (e.g., smaller skin lesions, moles, pimples; American Psychiatric Association 2013). This repetitive manipulation (usually with the fingernails) causes severe skin damage and clinically significant distress or impairment in important areas of functioning (Odlaug and Grant 2008). Some researchers have identified a high level of impulsivity, an enhanced emotion reactivity, or a reduced emotion regulation capacity in patients (Grant et al 2012; Roberts et al 2013; Snorrason et al 2010)
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